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    Rome IV Diagnostic Criteria for Cyclic Vomiting Syndrome

    Official Rome IV criteria for the diagnosis of cyclic vomiting syndrome.

    INSTRUCTIONS

    Use in patients with symptoms suggestive of cyclic vomiting syndrome (CVS) such as stereotypical episodes of vomiting with at least 3 discrete episodes in the prior year and 2 episodes in the past 6 months, occurring at least 1 week apart.

    Patients with any of the following features must be evaluated clinically for other diagnoses even though CVS may be present:

    • Signs or symptoms of GI bleeding.

    • Unexplained iron deficiency anemia.

    • Unintentional weight loss.

    • Palpable abdominal mass or lymphadenopathy on exam.

    • Family history of gastric cancer and no recent upper endoscopy.

    • Dysphagia.

    • Persistent vomiting.

    • Neurologic symptoms.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients presenting with stereotypical episodes of vomiting suggestive of cyclic vomiting syndrome (CVS) with at least two discrete episodes in the past 6 months. The diagnosis of CVS should be made by clinical history, physical examination, minimal laboratory tests, and a gastric emptying study.

    • CVS episodes are stereotypical; they have a characteristic presentation.

    • There are symptom-free periods between episodes. Episodes of vomiting should occur at least one week apart.

    • A diagnosis of CVS can only be made after a careful diagnostic workup reveals no evidence of organic, systemic, or metabolic disease to explain the symptoms. Workup may include upper endoscopy, small bowel radiography, computed tomography (CT) or magnetic resonance (MRI) enterography, and/or CT of the head.

    • CVS can be associated with rapid gastric emptying during symptom-free periods. They don’t have delayed gastric emptying.

    • CVS typically comprises 4 phases: (1) a pre-emetic period with pallor, diaphoresis, and nausea; (2) intense emesis, often with associated abdominal pain and/or diarrhea; (3) a recovery phase with gradual symptom resolution; and (4) an interepisodic period without vomiting.

    • Cannabinoid hyperemesis syndrome (CHS) may resemble CVS in presentation, and should be excluded.

    • Some patients may take hot showers for symptom relief but this is typically more associated with CHS.

    • Helps to make a diagnosis of cyclic vomiting syndrome when appropriate workup of upper GI symptoms is nondiagnostic.

    • Helps to distinguish symptoms from other functional disorders of nausea and vomiting, such as cannabinoid hyperemesis syndrome and chronic nausea and vomiting syndrome.

    • Helps to guide management of vomiting symptoms.

    Must have the following:

    For 3 months prior with symptom onset ≥6 months ago

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • David Cangemi, MD
    Reviewed By
    • William D. Chey, MD, AGAF, FACG, FACP
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • David Cangemi, MD
    Reviewed By
    • William D. Chey, MD, AGAF, FACG, FACP